Civil Service World interviews a social care commissioner about the effects of funding cuts - and it's not all bad.
“My job involves overseeing the planning and commissioning of social care services. I work with various stakeholders – including users – to plan service delivery, draw up specifications, and then procure the services. We involve partners such as neighbouring councils and the NHS to review funding arrangements, and develop local action plans in order to deliver the best support we can, while paying close attention to safeguarding vulnerable service users.
The cuts have been a mixed bag. On the one hand, it’s now a struggle to find money for preventative work, and services that were ‘nice to have’ are gone. There are also some seriously vulnerable people with complex and demanding needs who, despite meeting our very high eligibility criteria for social care, are being refused the new Personal Independence Payment – which is meant to fund some of the extra costs created by long-term health problems. This is money that really makes a difference in people’s lives, since many of them are unable to work.
On top of this financial loss, going through the process of being refused and then appealing can be incredibly stressful, and the impact of that can lead to increased costs for other council departments; I’ve heard horror stories of people having mental health episodes from the stress.
On the other hand, the cuts have had some positive aspects: there’s been a lot of cutting of fat, and some councils have really responded interestingly to the challenges they’ve been presented with. From a service point of view, a lot of the changes we’ve been forced into have actually been overdue.
Nowadays, we’re acting more like the private sector; there’s a realisation that we’ve got a job to get on and do. Those who are creative and motivated are excited by the transformation that’s happening – possibly the biggest change since the introduction of the welfare state. And despite the cuts, the quality of services is getting better and better.
Under the previous government, there was a lot of money to try out new solutions to problems. If it didn’t work, you’d try something else. In a time of austerity, you’ve got to get things right first time. Starting with a blank piece of paper can be scary, but it’s also exciting. Services have to meet users’ needs, and we can’t just guess at what those are: this has forced us to work more closely with people who use the services.
When you’re sat in the office – in your ivory tower – it’s easy to ignore what service users want, but it’s increasingly crucial to listen. Previously, social care commissioners weren’t willing to hand over power and were sceptical about people’s abilities to decide their care for themselves. There is still reluctance among some senior colleagues, but there’s been a shift from service users having things done to them to our working together on their care.
This is what we call the ‘personalisation agenda’. Co-production – a more equal relationship between service users and providers – is a favourite idea at the moment, but the government isn’t being prescriptive about it, which is a good thing.
The Department of Health has been a driving force behind a lot of the personalisation initiatives. Now service users are getting personal budgets to buy their social care from a list of providers; hopefully, competition will drive up standards. Until the mid-1990s it was illegal for councils to give cash directly to service users for them to spend, but now that’s exactly what’s happening.
What’s more, in the past the councils just picked one of the three main providers, which really limited choice for service users. They often chose the lowest cost providers, which reduced standards of care – but now there’s much more choice.
The system is certainly not perfect: one rule that needs to change is the HMRC prohibition on self-employed people providing care. That means that if service users spending their own budget need a personal assistant, they have to become employers – and that’s a real burden when people are aged over 65, and may have limited cognitive ability. Many who could benefit immensely often just don’t bother.
A trusted national database of personal assistants would also help – like TripAdvisor, but with more checks and balances. And councils could share more information about how much services cost them, because users going out there with their own budget need to make sure they’re getting the best deal.
When you talk to service users, the things that they bring up are usually really straightforward, such as having choice over their carer and directing their own care. If we listen to service users, act on what they say and the government, in turn, listens to us, we can create a better system.”